Down to the wire


Radiation safety and the interventional radiologist


On episode 15 of The Kinked Wire, Warren Krackov, MD, FSIR, speaks with radiation safety officer Joseph Ring, DO, about radiation safety in interventional radiology, measures IRs should be taking to protect themselves, and what medical students considering a career in interventional radiology should keep in mind. Listen at bit.ly/KWire-015f


This episode was published Nov. 10, 2020. It has been edited for flow.


Warren Krackov, MD, FSIR: Thanks so much for being here to give us an overview of radiation safety. My understanding of radiation in my specialty is similar to my view of chocolate cake—I need a little bit of it to survive, but if I have too much of it I’m in trouble. Joseph Ring, DO: I like the way you put that. Radiation protection in medicine is an interesting subject because you have to have it. I see two extremes: people who don’t worry about it at all, and those who worry too much. We want to exist in the middle ground.


There are studies out there that get people worked up—both patients and clinicians—about radiation exposures. But I like to look at it from what we deliver to our patients: During interventional procedures, our patients receive large radiation exposures and have no health impact from the radiation and no long-term health effects that we can quantify. That said, when you have very sick patients who have multiple procedures or imaging, that’s a different story. As the professionals completing the procedure, we get a much lower dose than our patients—which is a good comparison to show that we’re probably not looking at large radiation risks from the exposure we receive in the clinic. Not to say we shouldn’t minimize risks—but they’re relatively small.


However, I’m of the philosophy that if you can eliminate some exposure without complicating the procedure, why not? Many of my colleagues would call me overly conservative, but if I can stand around a corner and push an X-ray button and not get any exposure, or stand next to the patient and get all the exposure, which one am I going to pick?


It’s also important to note that in fluoroscopy, the dose delivered to the patient is about 1000x higher than what the clinician receives. So, it’s important to remember that the main goal of this is to reduce the exposure to the patient. Anything we do to reduce the exposure to the patient is going to reduce the exposure to the staff in the procedure room. That means using the lowest frame rate possible, focusing only on the area of interest, keeping your foot off the pedal if you’re not watching the image and wearing your radiation gown. I highly recommend wearing a vest, collar and skirt, because they will distribute the weight much better and reduce the fatigue level. Bear in mind that aprons are going to attenuate 95% plus of the radiation that’s incident on you.


WK: Is that why there’s the 1000x less number? Because we’re wearing lead? JR: No, it’s because the patient absorbs the radiation and scatters it.


WK: So we only get the scatter, and less than we normally would, if we distance properly and wear our apron. JR: Yes, you’re going to get 1000x less, but if you wear the lead apron, you’re going to cut it even more. We still call them lead aprons, but I recommend that you don’t buy a lead apron, you buy one of the newer composites because they’re 5–10 pounds lighter.


WK: Even with wearing gear, are there still risks? JR: There are. We always thought cataracts were something that would happen when you got a large radiation exposure, let’s say two gray and above. But we’ve recently learned that the threshold for cataracts is probably a lot lower, possibly around half a gray. That means it’s closer to the values that clinicians may see over a lifetime. So consider wearing leaded eyewear. You’ll want to have the wrap around eyewear or side shields, because a lot of the scatter will come in from the corners and up around the nose. They find that people


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